The goal of this R03 application is to capitalize on the experience of organizations that provide mental health services to deaf and hard-of-hearing persons by means of a national survey of the characteristics, operations and outreach strategies of these organizations. Deaf and hard-of-hearing persons routinely face many serious obstacles to obtaining mental health services, and consequently have disproportionately low use of these services despite at least equal rates of mental illness. We seek to begin to address these disparities by understanding the clinic and systems issues, and by eliciting the best practices of providers in service and outreach to these vulnerable populations. The specific aims of our study are: a) to undertake a national survey of organizations that provide mental health services to deaf and hard-of-hearing persons, focusing on structural and process domains of care;b) to describe differences in the number and characteristics of agencies by region and to delineate differences in service development and outreach strategies between organizations in urban and rural settings;and c) to elicit information from these organizations about barriers to mental health care for deaf and hard-of-hearing persons and prevalent practice patterns in the local healthcare environment. We plan to accomplish these specific aims by implementing a multimodal survey designed to collect information from these organizations on client characteristics, structural features and processes of care, barriers to treatment, and the local service environment. In order to increase both response rates and cultural sensitivity to the Deaf culture, the survey will be collected using paper, web-based, telephone, and videophone using American Sign Language. The survey will be directed at key informants for 267 organizations providing mental health services to deaf and hard-of-hearing persons, identified through two nationwide directories of specialized providers and recruited through telephone contact. Analysis of survey results will guide the development of evidence-based programs to improve service delivery and efforts to rigorously test new treatment models for these patients.